Position Applying For: O Teacher O Teacher Aide O Maintenance/Cleaner

EMPLOYMENT APPLICATION

Position Applying For: o Teacher o Teacher Aide o Maintenance/Cleaner

oFood Service Helper/Cafeteria o Bus Driver o Bus Monitor o Clerical/Support Staff

Districts Applying For: (Please check all the Districts you are willing to substitute in)

o Eldred o Fallsburg o Livingston Manor o Monticello

o Roscoe o Sullivan West o Sullivan County BOCES

Where did you hear about the position: (Please list exact place you heard about the position)

Newspaper (Which one):______o Career Builder o OLAS o Word of Mouth

Name: ______Date: ______

(Last) (First) (Middle Initial)

Address:______

(Street)

(City) (State) (Zip)

Telephone Number: ______

Have you ever been convicted of a crime? ______

(This item, in and of itself, would not necessarily keep you from being hired)

If yes, explain: ______

Do you have any reservation about signing an Oath of Allegiance as prescribed by Section 3002 of the New York State Education Law? ______

EDUCATION BACKGROUND

High School ______

Name of Street City, State, ZIP

Type of Diploma ______

Complete, if applicable:

College (Undergraduate) ______

Name of Street City, State, ZIP

Type of Degree ______

Major ______Minor ______

College (Graduate) ______Name of Street City, State, ZIP

Type of Degree ______

Major ______Minor ______

Number of semester hours above highest degree ______

EMPLOYMENT HISTORY List previous work experiences you have had (use reverse side if necessary:)

Employer Address Telephone Type of Work From:To

Have you ever been fired or asked to resign any former position? ______

If yes, where? ______

-2-

REFERENCES: Will be checked. Use full, correctly spelled names, complete Street, City, State and ZIP plus Area Code and Telephone Number. List employers under whom you have worked and others who have first-hand knowledge of your character, personality and abilities. Personal references should be other than family.

Name / Title Place of Employment / Address Telephone

EARLIEST DATE YOU WOULD BE ABLE TO BEGIN WORK: ______

I understand that misrepresentation or omission of facts called for in this application is cause for cancellation of the application and/or immediate dismissal from the Sullivan County School Districts and/or Sullivan County BOCES, if employed. My signature below authorizes Sullivan County School Districts and/or Sullivan County BOCES to request references and release information regarding my qualifications from those people I have listed in my application. I also give permission to any listed employer to submit references upon the School District and/or BOCES' written request.

______

Applicant's Signature

FOR OFFICE USE ONLY:

Applicant interviewed by: ______Date ______

-3-

Sullivan County BOCES is an Equal Opportunity Employer.